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Biomedical subjects

L Grande

Publications and source records attributed to L Grande.

At least 55 records · Page 3Linked to original sources
PubMed1998

Epithelial cell hyperproliferation after biliopancreatic reflux into the esophagus of rats.

BACKGROUND: Chronic reflux of duodenal contents into the esophagus of rats produces severe esophagitis and exerts a co-carcinogenic effect on the proliferating cells by enhancing the formation of nitrosamine-induced esophageal carcinomas. We investigated the effect of the different components of the duodenal reflux on the epithelial cell proliferation of the lower esophagus. METHODS: Sprague-Dawley rats underwent three surgical reflux models (biliopancreatic, pancreatic, and biliary) and a sham operation. Animals were sacrificed at 72 hours, 6 weeks, and 9 weeks after the operation. Histology and cell proliferation, determined by ornithine decarboxylase activity, polyamine (putrescine, spermidine, spermine) levels, and proliferating cell nuclear antigen labeling index of the basal and suprabasal layers, were studied in the distal esophagus. RESULTS: Both biliopancreatic and pancreatic reflux induced severe esophagitis starting on week 6. Suprabasal proliferating cell nuclear antigen labeling index significantly increased throughout the 9 weeks of the study in the biliopancreatic and pancreatic reflux groups, although this increase was earlier in the former group. Ornithine decarboxylase activity and polyamine levels were significantly increased in the biliopancreatic and pancreatic groups on week 6, decreasing on week 9. CONCLUSIONS: Increased esophageal cell proliferation after both biliopancreatic and pancreatic reflux into the lower esophagus may therefore be one mechanism by which duodenal-content reflux stimulates esophageal carcinogenesis in experimental animals.

Animals↗
PubMed1998

Rapidly growing choroidal metastasis: case report.

A rapidly growing choroidal metastasis from an occult carcinoma is described. The patient was first seen with a loss of visual acuity. The fundus examination showed a non-pigmented solid mass located at the posterior pole. Clinical history, echographic characteristics and tumour growth kinetics are described in detail.

Adenocarcinoma↗
PubMed1998

Immersion technique in anterior-segment examination.

Ultrabiomicroscopy, using equipment with high-frequency transducers, is a very simple method for the study of superficial ocular structures. Nevertheless, these equipment are very expensive and not commonly used. The most widespread and used instrumentations are still provided with lower-frequency probes. These are sufficient to show the anterior segment of the eye. In this work we underline the diagnostic importance of this method and, in some cases, the therapeutic role.

Anterior Eye Segment↗
PubMed1998

Randomized trial of adjuvant chemotherapy with mitomycin plus ftorafur versus mitomycin alone in resected locally advanced gastric cancer.

PURPOSE: We performed a clinical trial to determine whether postoperative adjuvant chemotherapy with two drugs versus one drug could prolong survival. PATIENTS AND METHODS: From 1985 to 1996, 85 patients with completely resected locally advanced gastric cancer were enrolled. The subjects were randomized into two treatment groups, as follows: mitomycin (MMC) 10 to 20 mg/m2 intravenously (i.v.) on day 1 every 6 weeks plus ftorafur (FT) 500 mg/m2/d for 36 consecutive days; or MMC alone, 10 to 20 mg/m2 i.v. every 6 weeks. All courses were repeated four times. RESULTS: After a median follow-up duration of 62 months, the overall 5-year survival rates were 67% for the MMC-FT group versus 44% for the MMC group (P = .04). Subgroup analysis to compare survival curves using the method of Mantel-Cox showed survival rates significantly in favor of the MMC-FT group in the subsets of patients with node-negative disease (P = .01) and those whose disease was stage IB or II (P = .008). CONCLUSION: Significantly better survival results were observed for MMC-FT versus MMC alone. Subset analysis suggest a strong benefit in patients with node-negative and early-stage resected gastric cancer.

Adenocarcinoma↗
PubMed1998

Expanded liver donor age over 60 years for hepatic transplantation.

With a growing discrepancy between the number of liver candidates and donors, traditional donor selection criteria have been greatly changed to meet the need for donor livers. Older donors are a readily available source of livers that can significantly augment the donor pool. Our series demonstrated that the course and the outcome of orthotopic liver transplantation were not influenced by donor age, as indicated by the absence of significant differences in the incidence of primary nonfunction, arterial and biliary complications, postoperative function tests, and graft and patient survival. These results indicate that age per se should not be considered as a major criteria for accepting or rejecting donor livers for transplantation.

Adult↗
PubMed1998

[Endoscopic ultrasonography in the staging of esophageal cancer. Therapeutic implications].

Endoscopic ultrasonography (EUS) provides accurate visualization of the different layers of the gastrointestinal wall and surrounding structures, allowing TN staging of tumors prior surgery. The aim of this study was to evaluate the sensitivity, specificity and accuracy of EUS in the staging of esophageal carcinoma as well as its applicability and usefulness in tumors with nontraversable stenoses. EUS was performed in 43 patients with esophageal carcinoma. The technique was carried out with a radial echoendoscope under sedation with i.v. midazolam. Both, the infiltration of the tumor through the layers of the esophageal wall (T staging) and the presence of lymph nodes in different areas (N and M staging) were determined. In cases with nontraversable stenoses, only the proximal tumor margin was assessed by means of EUS. EUS showed T1 stage in only one case and more advanced stages in the remaining patients: T2 (n = 12), T3 (n = 22) and T4 (n = 4). We know the outcome of 28 patients, 14 of whom underwent surgery. In these patients, the sensitivity for T and N staging was 86% and 92% respectively, and the accuracy 86% in both. Both, T and N, were overstaged in one case (7%) and understaged in another (7%). The tumor caused nontraversable stenoses in 59% of patients (n = 26). In 4 patients the staging could not be assessed with sufficient reliability. In the subgroup of patients with nontraversable stenoses who underwent surgery, the accuracy of EUS when comparing with histopathology was 80%. Endoscopic ultrasonography has a high sensitivity and accuracy in the staging of esophageal tumors even in cases with nontraversable stenoses.

Aged↗
PubMed1997

Liver transplantation in patients with Caroli's disease and recurrent cholangitis.

Caroli's disease is an uncommon congenital disorder of the intrahepatic biliary tree. It is characterized by multiple and segmental dilatations of the bile ducts. The clinical course of Caroli's disease is often complicated by recurrent episodes of bacterial cholangitis that seriously impair the patient's quality of life. Despite wide spectrum antimicrobial agents, medical treatment of cholangitis is frequently unsuccessful in patients with Caroli's disease due to the persistence of bacteria in dilatated bile ducts. Other therapies, including internal or external biliary drainages and various surgical or endoscopic procedures, have been used in the treatment of Caroli's disease, with poor results. There are no previous reports in the literature of liver transplantation for recurrent cholangitis in patients with Caroli's disease. We present two such cases, in which cholangitis is resolved.

Adult↗
PubMed1997

Liver transplantation for alcoholic cirrhosis with anti-HCV antibodies.

The results of orthotopic liver transplantation (OLT) in patients with alcoholic liver cirrhosis (ALC) are currently similar to those obtained in patients with other indications. However, the frequent association of ALC with hepatitis C virus (HCV) infection may impair these results. We retrospectively studied the consequences of HCV infection on survival and graft function in 59 patients with ALC undergoing OLT. Patients were classified into two groups depending on their HCV serology before transplantation: group 1 comprised 24 anti-HCV-positive patients, and group 2, 35 anti-HCV-negative patients. Patient and graft survival were similar in both groups. Liver function tests 1 and 4 years after OLT showed AST and ALT values that were significantly higher in group 1 patients and post-transplant histologically proven chronic hepatitis was found in 45% and 61% of these patients at 1 and 4 years, respectively. We conclude that pretransplant HCV infection in patients with ALC does not affect survival after OLT. However, one must bear in mind the high incidence of post-transplant chronic hepatitis secondary to recurrence of HCV infection and be cautious when drawing this conclusion.

Adult↗
PubMed1997

Postoperative complications of laparoscopic-assisted colectomy.

BACKGROUND: This study was performed to prospectively assess the complications of 118 consecutive patients who underwent laparoscopic assisted colorectal resections. METHODS: The variables included were: indication for surgery, type of resection, duration of operation, duration of postoperative ileus, length of hospital stay, port-site recurrence, and complications in relation to the laparoscopic technique. RESULTS: 118 Laparoscopic-assisted procedures were performed between July 1992 and October 1995. Surgical indications were: 106 patients for colonic malignancy, six for diverticulitis, two for Crohn's disease, two for benign polyps, one for endometriosis, and one for ischemic colitis. Fifteen patients required conversion to open techniques for completion of the operations (12.7%). The mean operating time was 168.8 min. The amount of operative blood loss was 98 ml. The mean time for passing flatus was 36 +/- 16 h. Mean postoperative stay was 5.4 (range 3-13) days. Eight patients (6.8%) sustained complications: four unrelated to laparoscopy (three wound infection, one anastomotic leak); and four complications related to the laparoscopic approach: one small-bowel obstruction, one trocar injury, one rotation of the anastomosis, and one misdiagnosed synchronous adenocarcinoma. CONCLUSIONS: We suggest that with the development of improved technical devices and more experience, the indications for laparoscopic colectomy should continue to expand. The low incidence of infectious complications suggests an important role for the laparoscopic approach to colorectal surgery.

Adult↗
PubMed1997

Chest pain at rest in patients with coronary artery disease. Myocardial ischemia, esophageal dysfunction, or panic disorder?

Severe nonexertional (resting) chest pain may be due to myocardial ischemia, esophageal dysfunction, psychiatric disorder, or any combination thereof and frequently poses a difficult diagnostic challenge. Our aim was to investigate causes of chest pain in patients with coronary artery disease. Forty-five patients with angiographically proven obstructive coronary lesions and recurrent chest pain at rest were studied; 18 had refractory pain despite cardiac therapy (problem group), and 27 had documented myocardial ischemia (control group). Esophageal manometry, edrophonium provocation, 24-hr pH studies, and psychiatric interview were performed in all patients. The clinical evolution and the outcome of specific treatment during follow-up was used to establish the etiology of chest pain. Esophageal dysfunction was identified in all problem patients and in 52% of controls, and the esophagus was incriminated as the source of pain in 8 (44%) and 5 (18.5%), respectively. After a mean follow-up of 49 months (range 24-76 months), the cause of chest pain in the problem group was identified as panic disorder in 9 patients (50%), gastroesophageal reflux in 6 (33%), esophageal dysmotility in 2 (11%), and gallstone disease in 1 (6%). Of the control patients, 18 (67%) had ischemic pain alone, while 9 had concurrent causes: panic disorder in 5 (19%) and esophageal dysfunction in 4 (15%). Esophageal dysfunction and psychiatric disturbances are common in patients with coronary artery disease presenting with resting chest pain, and may contribute to patients' symptoms.

Case-Control Studies↗
PubMed1997

Effects of red wine on 24-hour esophageal pH and pressures in healthy volunteers.

The purpose of this study was to assess the effects of red wine taken with meals on esophageal motility, esophageal exposure to acid, and gastric pH. Following a randomized design, 14 healthy male volunteers (mean age 25 years, range 18-35 years were given 360 ml of red wine or tap water during lunch or dinner. All subjects underwent ambulatory 24-hr esophageal motility and esophagogastric pH monitoring studies. Three different periods were analyzed: during meals (30 min), postprandial (3 hr), and 8-hr supine. Two volunteers complained of heartburn after wine ingestion. An increase in the number of high amplitude waves (> 125 mm Hg, 95th percentile of our motility unit controls) was observed during meals accompanied by wine: water 1.2 (0-10.2), wine 1.6 (0-32.6), P = 0.02 [median (range)]. No other esophageal motility changes occurred. Percent reflux time increased during the postprandial period after wine ingestion in comparison with water: 1.7 (0-14.9) vs 0.1 (0-0.8), P < 0.05. Gastric pH was unaffected by the type of drink. Ingestion of moderate amounts of red wine with meals increases postprandial esophageal exposure to gastric acid in healthy persons.

Adult↗
PubMed1997

Duodenal content reflux esophagitis in the rat: an animal model for the ulcer-associated cell lineage (UACL)?

We have studied the histological changes observed in the mucosa of 10 rats in the region of a esophagojejunostomy to evaluate it as a model for the ulcer-associated cell lineage (UACL). In man, the UACL has a distinctive morphology, proliferative organization, and pattern of trefoil peptide localization. We have therefore examined these aspects aided by immunohistochemistry and in situ hybridization to the trefoil peptides TFF1, TFF2, and TFF3. Only TFF2 was studied by immunohistochemistry, whereas the mRNAs for all three peptides were examined by in situ hybridization using 35S-labeled riboprobes. The marker MIB-1 to the Ki67 proliferation-related antigen was used to examine the proliferative organization of UACL-like changes. In all cases, columnar epithelialization of the distal esophagus was seen, and in all, glands with morphological and gene expression attributes of the UACL were identified. TFF3 mRNA localized patchily throughout the UACL, whereas TFF1 mRNA was found in the upper portions of the lineage and TFF2 mRNA and its product in the acini. These lineages showed virtually no intrinsic proliferative activity. These appearances are similar to those seen in early human UACL, and we therefore propose this that this represents the first published animal model of this lineage.

Animals↗
PubMed1997

[De novo tumors in adult patients with hepatic transplant].

The incidence of de novo neoplasms was analyzed in 340 patients with liver transplantation who survived more than 2 months post transplantation. Sixteen (4.7%) patients developed a new tumor following transplantation. The most frequent tumor observed was a lymphoma which was detected in four patients (1.2%). In three of the four lymphomas histologic diagnosis of non Hodgkin phenotype B lymphoma was confirmed and in three patients the central nervous system was involved. The remaining tumors consisted of two cases of adenocarcinoma of the colon, papillary carcinoma of the urinary bladder and ductal breast cancer (0.6%) for each of these tumors and one case of cervical cancer, adenocarcinoma of the small intestine, Kaposi sarcoma, laryngeal carcinoma, pharyngeal carcinoma and malignant melanoma (0.3% for each tumor). None of the patients developed more than one tumor. The mean time to the appearance of the tumors was 28 months (range: 3-52 months). These results suggest that de novo neoplasms in patients with liver transplantation are relatively frequent, particularly lymphoma.

Adult↗